Insurance coverage for your breast reduction operation
There is a big debate about whether the breast reduction surgical procedures are considered a plastic surgery or re- constructive surgery. Most people...
There is a big debate about whether the breast reduction surgical procedures are considered a plastic surgery or re- constructive surgery. Most people are not interested in this debate, all what they want is the result. They need to decrease the size of their breasts whether it is considered a plastic or reconstructive surgery. But, this debate has a huge impact on you too because it affect your financing for the operation.
If you need this operation for a medical indication, as sometimes the large size breast may cause lot of pain and may interfere with your daily life, then your insurance policy will cover a large portion of your operation expenses according to the insurance policy you have. Below we will show you how much your insurance company will cover.
If the operation is done on your choice, as you want to enjoy a better shape for your breasts or so then most insurance companies will not cover such procedure. To avoid any misunderstands, check with your surgeon about the fees and expenses and hand him your insurance number so he can make sure that you are covered. After that, double check with your insurance account agent about your policy.
Some insurance policies apply deductibles. This means that you have to pay an amount of money and the company pays a percent of the remaining money. For example if you have deductibles of $100 and your breast reduction operation costs $1000 so, the remaining portion will be $900. Some insurance policies will pay anywhere from 60 to 90 percent of the amount. Add the remaining to the deductible amount and this will be your share.
In some cases the patient condition may need one or two days in the hospital after the operation, the hospitalization cost is not included in your insurance and you have to pay it yourself.
Some medical insurance premiums have different method in covering medical services like paying a fixed amount or a fixed percentage regardless of the cost. The client is responsible for the rest of the cost and should pay for it herself.
Every case has its own condition according to the insurance policy so; make sure to discuss it with your account manager or insurance agent before you go for your breast reduction operation.
Your information re insurance cover for breast reductions in Australia is incorrect. In Australia, breast reduction is government/Medicare approved. It does NOT need to be justified in terms of symptoms, size, etc. As it has a Medicare number, all health insurances are obligated to recognise the procedure. They cannot decline on any grounds. Medicare and the Health Insurance pay the government set “Schedule Fee” however most surgeons charge more than this ie the “gap”.
The Australian medical system is completely different to the USA and fortunately we are not dictated to by beaurocrats in Insurance offices.
Dr Steve Merten, Plastic Surgeon, Sydney, Australia
wow it is nice to find such a serious response here from a man who have title Dr,in front of there name,thanks doc,nice to know Australians Doctors has Idealism better then other doctors from other continent
reason what make most people do this operation seems tends to health reason,insurance should cover this one,longer they wait more people who suffer could be die
Sure medicare covers some of the costs of a breast reduction but the reality is it covers hardly any of it. As at 5/3/2010 the medicare scheduled fee is $851- of which medicare covers 75% or $638.25. This means a patient can be out of pocket thousands given most surgeons charge on average $8000 for the surgery. On top of that there is hospital, that can be covered by private hospital & the anaesthetist bill too. Beware ladies the gap can be quite significant. The sooner the government takes a good hard look at scheduled fee the better!!!
Does anybody know a heath fund that will cover you for this procedure I have tried to do some online research but not much help not enough details on what they cover. Also can anybody recommend a Plastic Surgeon in Victoria I do have referral for one doctor but i would like to speak to more than one as it is a very major decision I have pondered on for years and just want to be happy with the surgeon I choose.